Application progress on perioperative oral nutritional supplements / 中国实用护理杂志

Patients in the perioperative period are often at risk of malnutrition due to the disease itself, surgical trauma, stress, and fasting. Oral nutritional supplementation is widely used in the perioperative period as the first choice for nutritional therapy. This article summarizes the effects, usage, adverse reactions and coping methods of oral nutritional supplementation during perioperative period, aiming to understand the current status of oral nutritional supplementation in perioperative period, and provide reference for subsequent application research of oral nutritional supplementation in perioperative period.

Can oral nutritional supplements increase energy and protein intake among hospitalized patients? / ¿Los suplementos nutricionales orales pueden aumentar la energía y la proteína en pacientes hospitalizados?

ABSTRACT Background: Oral nutritional supplements aim at offsetting dietary deficits and helping to meet energy and protein targets. Due to the absence of data about their role in food intake, it is necessary to evaluate the contribution of these products to the estimated needs of hospitalized patients. Methods: This is a prospective longitudinal study with hospitalized patients over 18 years of age, admitted to a public university hospital, who were given oral nutritional supplements, according to clinical guidelines. Food intake was quantified throughout the period such products were prescribed. Results: 805-day food intake follow-up and record of 128 patients, who took supplements for 6.4 days on average. The use of nutritional supplements demonstrated a significant contribution to the input of both energy (1576 kcal/day versus 1263 kcal/day, p<0.001) and protein (68.7 g/day versus 50.3 g/day, p<0.001). Conclusions: Nutritional supplements help increase food intake and achieve nutritional goals when prescribed in a hospital setting.

RESUMEN Antecedentes: los suplementos nutricionales orales tienen como objetivo compensar los déficits dietéticos y ayudar a cumplir los objetivos de energía y proteínas. Debido a la ausencia de datos sobre su papel en la ingesta de alimentos, es necesario evaluar la contribución de estos productos a las necesidades estimadas de los pacientes hospitalizados. Métodos: Este es un estudio longitudinal prospectivo con pacientes hospitalizados mayores de 18 años, ingresados en un hospital universitario público, que recibieron suplementos nutricionales orales, según la derivación clínica. La ingesta de alimentos se cuantificó durante todo el período en que se prescribieron dichos productos. Resultados: seguimiento de la ingesta alimentaria de 805 días y registro de 128 pacientes, que tomaron suplementos durante 6,4 días en promedio. El uso de suplementos nutricionales demostró una contribución significativa al aporte de energía (1576 kcal/día versus 1263 kcal/día, p< 0,001) y proteína (68,7 g/día versus 50,3 g/día, p<0,001). Conclusiones: los suplementos nutricionales ayudan a aumentar la ingesta de alimentos y alcanzar objetivos nutricionales cuando se prescriben en un entorno hospitalario.

Nutritional management for Alzheimer ' s disease in all stages: mild, moderate, and severe

Alzheimer's disease corresponds to 50­70% of all dementia syndromes, classified as a progressive neurodegenerative disease showing diffuse cortical atrophy with three stages of evolution: mild, moderate, and severe. Behavioral symptoms and memory loss are major manifestations of the disease. Non-pharmacological interventions are essential to improve the quality of life of these patients. Interdisciplinary assistance is essential throughout the disease course. Regarding nutrition for patients with Alzheimer's disease, weight loss and behavioral changes related to food are major objects of scientific study, as they trigger deterioration of the quality of life of patients and caregivers. Knowing which nutritional guidelines should be used helps in clinical decisions. The study of nutrition in dementia is, therefore, critical for patient management.

Effect of oral nutritional supplementation on nutritional status and quality of life in patients with gastric cancer after operation(23 cases RCT observations) / 中华临床营养杂志

Objective To investigate the effect of oral nutritional supplementation on the nutritional status and quality of life in patients with gastric cancer after operation.Methods In this prospective,single blind,randomized,controlled clinical study,25 postoperative patients with gastric cancer received neoadjuvant chemotherapy in outpatient clinic were enrolled.All patients received dietary guidance.In the intervention group,in addition to standard diet,oral nutritional supplements with 2 090 kJ/d of Intacted Protein Enteral Nutrition Powder were added,which lasted 90 days.The changes of body mass,body mass index(BMI),hemoglobin,prealbumin,albumin,gastrointestinal function score,and life quality score 30,60,and 90 days after discharge were recorded.Patients on standard diets were used as the control group.Results In the intervention group,the body mass increased by(0.66 ±1.47)kg 60 d after discharge and(-0.90±1.82)kg on 90 d after discharge,which were [60 d:(-5.13±1.79)kg,90 d:(-9.56±2.44)kg] in the control group,and the difference was statistically significant(P=0.027,P=0.015).The BMI of intervention group increased by(0.20 ±0.55)kg/m2 on 60 d and(-0.32±0.55)kg/m2 on 90 d after discharge,which were(-2.06±0.67)kg/m2 on 60d and(-3.21± 0.73)kg/m2 on 90 d in the control group(P=0.014,P=0.003).There was no significant difference in terms of serum albumin,prealbumin and other laboratory indicators.Intestinal functional status and quality of life also showed no significant difference between these two groups.ConclusionOral nutrition supplementation can reduce the body mass loss and improve the nutritional status in patients with gastric cancer during chemotherapy after operation.

Clinical study on nutriti0nal interventi0n in patients with Alzheimer(s) disease / 肠外与肠内营养

Objective:To explore the effects of nutritional intervention on the nutritional status,cognitive function and activities of daily living (ADL) in patients with Alzheimer's Disease (AD).Methods:90 AD patients were randomly divided into the control group and the intervention group,with 45 cases in each group.Patients in the control group received anti-dementia drugs,and patients in the intervention group additionally received TPF-T as the oral nutritional supplement.The nutritional status and nutritional biochemical indicators,cognitive function and ADL of two groups were evaluated when enrolled and 6 months later after the treatment.Results:After 6 months'treatment,the nutritional status,MMSE,ADL scores and nutritional indicators of patients in the intervention group were significantly improved compared to the control group (P ＜ 0.05).Conclusion:Nutritional intervention can effectively improve the nutritional status,cognitive function and ADL of patients with dementia.

Use of Oral Nutritional Supplements for Patients with Diabetes / 임상당뇨병

Dietary counseling and oral nutritional supplements (ONS) should be considered to increase the nutritional intake of people malnourished or at risk of malnutrition. These supplements are typically ready-made liquids and contain a balanced mix of energy, protein, and micronutrients. The diabetes-specific ONS are specifically designed for patients with hyperglycemia or diabetes mellitus in order to provide better glycemic control such as postprandial glucose and HbA1c compared to the standard ONS. These supplements are lower in carbohydrates and higher in fat than standard supplements and are rich in monounsaturated fats. Using diabetes-specific ONS in malnourished diabetic patients can allow increasing energy intake while maintaining glucose control and improving nutritional status and also providing economic benefits. However, inadequate intake of ONS that do not fit the patient's condition can be a problem. Therefore, when using ONS for patients with diabetes, it is necessary to clinically evaluate the nutritional status of the patient and to provide individualized education and management accordingly.

A Community Based Dietetic-Led Service to Extend the Citywide Care of Patients at Risk of Malnutrition and to Reduce Inappropriate Prescribing Costs of Oral Nutritional Supplements.

Background: Malnutrition is a cause and consequence of disease, affecting at least 3 million UK adults (Elia, 2010 [1]) of which 93% are in the community at a cost to the NHS of £13 billion/year, BDA [2]. Food should be first line treatment for anyone identified as at risk of malnutrition, Crawley and Hocking [3]. Oral nutritional supplements (ONS) are often inappropriately prescribed to treat malnutrition Gall et al. [4]. The current annual spend on ONS in Leeds is approximately £1.7million for around 1500 patients. This innovative service aims to receive 1000 new patient referrals and as a consequence make £300,000 of savings through clinical and cost effective use of ONS usage in the community. Process: The success of a pilot project led to the citywide dietetic-led service. This process is outlined below. Ethics approval was not required. 1. A 12 month pilot project in Leeds North CCG involved a retrospective audit which was carried out with 8 GP practices in 2011/12, to assess current ONS prescribing. Concurrently all Leeds North CCG practices could refer any adult patient on ONS, directly to the dietetic team. 2. This pilot project identified 315 people on ONS with 83 patients assessed and reviewed by a dietitian. The audit showed less than 20% of patients were appropriately prescribed ONS. Dietetic intervention made an average saving of £2.62 per patient per day by getting the right patient on the right product for the right length of time. This equates to an annual saving of £79,372.90. 3. The impact of this work led to investment (until 03/2014) to implement a city wide community ‘Eating and Drinking Team’ to raise awareness of the need to identify and treat malnutrition, through nutritional screening, promoting ‘food first’ principles, appropriate prescribing practices, and pathways, to ensure the best outcomes for Leeds residents. 4. Targets for the new team were set at 1000 new patient referrals, with 3000 patient contacts to enable annual cost savings of 20% per year (approx £300,000). Outcomes: In the first two full quarters of activity (Jan-Jun 2013), the service has: Cost savings are generated by preventing inappropriate prescribing by getting the right patient on the right product for the right length of time. Increase in referrals, activity and outcomes (not discussed here) demonstrate the need for a dietetic-led service, with additional and longer term investment to recognise the referral rate and the savings. Conclusion: Dietetic-led interventions for reducing the risk of malnutrition can be successful in promoting the role of the dietitian and achieving significant cost savings.